Gtube flushes

[babiesbreath]

There seems to be some debate about proper administration of gtube flushes, meds, and feedings at our facility. Let's say, for example, I have a pt. with the following orders: Glucerna at 70cc/hr per gtube continuous, Flush gtube with 200cc H2O Q4h, and the pt. receives various meds (includes metamucil twice a day - very hard to get down gtube!) at each med pass (which are set up at 12mn, 6am, 12noon, and 6pm) - gtube flushes are set up 12-4-8-12-4-8. In your opinion, how do you properly administer the water flushes and meds? And, are your gtube flushes to used with your med pass, for example, do you have 400cc/shift to flush and give meds with or do you "add" water for med administration?

[nerdtonurse?, BSN, RN]

If the person is fluid restricted -- dialysis, CHF, etc. -- then I use the regularly scheduled flush amount at time for the med pass -- we've had some really ticklish dialysis patients and fluid overload CHF'rs who literally didn't need 1 extra ml beyond their bare minimum. If they're dialysis pts, I'd use the dialysis nurse as a resource and get their opinion.

If they're okay otherwise (hx. of CVA but no cardiac or kidney problems, no crackles in their lungs), then I wouldn't get that worried about the occasional extra 100 cc to get the metamucil down the tube.

[MichelleB34]

When I have had similar orders I will sometimes use the shift flush(es) during my med pass. When you are giving metamucil you can easily give 200cc of water or more so there is your first flush. Also I wouldn't mix the metamucil until right before you give it. The longer it sits there the thicker it will get. I also mix warm water in with the crushed pills to help dissolve them.

[babiesbreath]

Ok, now what about your flushes inbetween meds? Some say that when giving meds you are to flush with 30-50cc h2o between each med PLUS the routine flush. If I'm using the same orders as above and flush with 200cc at one med pass and then 50cc after each med, I could easily wind up using alot of extra h2o, and be giving 400 - 600cc at a time (say the pt. gets 6 different meds at 8am). I personally, in general, check for placement then flush the tube with 15-30cc to clear the line, then start giving my meds, using 10-30cc inbetween each med depending on what the med is and how much flush I have to work with, rarely going over my original routine flush of, as in this case, 200cc. And what about "saving" water? A few nurses only flush the line clear with the first meds pass, if the pt. gets no meds and then use the remaining water PLUS the next scheduled 200cc for the med pass with the most meds.

[CoffeeRTC, BSN, RN]

Unless they are being watched for fluid volume overload and are on I/ O I would give the flush order as due and then the extra flush needed for the meds. Your facility should have a P and P in place as to what amt should be used with med admin.

I work LTC and for the most part, these folks can use ever little bit of extra fluids unless of course they are chfers etc.